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Inverclyde Royal Hospital

Monday, October 18, 2004.
Annabel Goldie MSP makes submission to NHS Argyll & Clyde regarding their consultation

Annabel Goldie MSP said in her initial correspondence with me, that she would make a submission to NHS Argyll & Clyde regarding their consultation and send me a copy.

She has now done this and you can see what she wrote below:


The Consultation, 'Shaping the Future' - The Clinical Strategy for NHS Argyll & Clyde, outlines a number of issues which are fundamental in the provision of health care. It is recognised that delivering the current services is challenging due to a number of factors which include financial and geographical pressures, staffing issues and the important relationship between primary and secondary care providers. However it is vital that the restructuring of these health care services is done with the patient as the primary focus and that there is an acceptance by the Health Board of the simple, fundamental principles underpinning such delivery.

The Health Board in acknowledging these principles may be confronted with the unwelcome realisation that for a variety of reasons it cannot deliver health care in implement of these principles. That is a separate but vital issue in itself which requires the Health Board to raise that issue with the Scottish Executive. It is not acceptable that inability to implement the fundamental principles is used as justification for abandoning or departing from the principles themselves.

The Principles

It is submitted that these are accessibility, provision of adequate infrastructure, provision of suitably trained and qualified personnel and where appropriate provision of centres of specialisation.

It has been made clear to me from meetings and representations from constituents that the principal fear in both the Inverclyde and Vale of Leven areas is the major practical problem of accessing facilities at the Royal Alexandria Hospital (R.A.H.) in Paisley. That fear is legitimate and substantive for geographical reasons which are self evident. It has consequences not only for the safety of the patient but also for family and friends desirous of visiting the patient. That fear arises from the proposals to cut services at Inverclyde Royal and Vale of Leven.

There is a secondary implication arising from such cuts. That is the very real apprehension that the remaining services at these two hospitals will no longer represent a critical mass, that recruitment will become more difficult and that the initial withdrawal of services will be the catalyst for further irreversible rundown.

While it is acknowledged that certain clinical procedures can only be carried out in a specialist environment and the public acknowledges and accepts that in such a minority of cases, travel and distance are unavoidable, the public does not accept that, for example, accident and emergency services or general surgical procedures should only be carried out in a specialised environment.

In the absence of workable alternatives or options being advanced in the consultation document, it is difficult to regard this consultation process as being free from defect.

If on the other hand the consultation process is to inform the Board as to what is not acceptable thereby enabling the Board to consult further with the Scottish Executive then it may be a valuable source of information but cannot be the template for future change.

It is essential before any further withdrawal of services is proposed that other options be explored. For example, there is an assumption that clinical staff are in a fixed physical location requiring patients to travel. With continuous I.T. advances, why can clinical staff not become mobile and a rotation model investigated?

The Solutions Group's recommendations for the Belford and Lorne and Islands Hospitals suggest such flexibility has been adopted in finding an answer for that area. Why can such flexibility not be investigated for the much more densely populated areas of Inverclyde and Vale of Leven?

Naturally attention has tended to focus on hospitals and facilities likely to face cuts but I would now like to direct this part of my submission to the implications of such cuts on the proposed centre of specialisation, the R.A.H. in Paisley.

Constituents currently relying on the R.A.H. are expressing concern about the impact of redirection of patients to that hospital from Inverclyde Royal and Vale of Leven.

There is currently huge pressure on the infrastructure of the R.A.H. Location wise it is not ideally suited to patient or visitor needs. Car parking is an obvious pressure point but less visible and not addressed in detail in the consultation document is the clinical capacity of the R.A.H. to cope with additional patients. It is unacceptable to place further pressure on that facility without demonstrable evidence from robust examination that the facility can cope. In the absence of such evidence, the R.A.H. has to be excluded from the proposals.


In conclusion I urge the Board to address other clinical options and models and to publish these for public consultation. Any curtailment of facilities and services at the current time based on the existing consultation is unacceptable. I also urge the Board to share with the Scottish Executive the clamant public desire for the continuance of general surgical procedures and accident and emergency facilities at both Inverclyde Royal and Vale of Leven Hospitals.

Annabel M Goldie MSP
West of Scotland Region
Tuesday 12th October 2004


Wednesday, June 09, 2004.
Inverclyde Royal Hospital and the future of Inverclyde

Inverclyde has been rocked recently with the news, although not unexpected, that the Argyll and Clyde health board are proposing huge cut-backs at Inverclyde Royal Hospital (IRH) and the closure of Ravenscraig Hospital as they try to slash a £40 million deficit, the Greenock Telegraph reported.

The cuts would include the IRH losing its 24 hour accident and emergency unit, with the Royal Alexandra in Paisley becoming our local unit, and the requirement that all patients requiring surgery would go to Paisley. Last year the IRH lost their consultant-led maternity department despite a huge public campaign opposing the move. Eventually it seems that the IRH could become nothing more than a large health centre.

I wrote to our MP (David Cairns), our MSP (Duncan McNeil), our local councillor (Eric Forbes), and all 7 regional MSPs for the West of Scotland regarding this situation and the future of Inverclyde in general.

Some of the points that I highlighed included:

  • Would young people who have left Inverclyde want to return with the hospital so far away?
  • The RAH in Paisley is not the easiest hospital to reach, due to its location in the back of Paisley.
  • With the Southern General in Govan just a few minutes further up the road, and easier to reach, would people skip the RAH and go there instead?
  • It is ludicrous to centralise so many services at the RAH when another main hospital, the Southern General, is only a short distance away.
  • Mention was made of the Ear, Nose and Throat (ENT) ward which was transferred to Paisley some time ago.
  • Why should an area like Inverclyde have less than what it had in the past. Surely the cuts are a backwards step? [Note, in one of the Telegraph stories, "Home front battle to stop hospital cuts", campaigner Nell McFadden says it reminds her of what it was like here over 50 years ago.]
  • A Greenock Telegraph report said that the present schools capacity is 8,000 but there are only 5,700 pupils. This will fall to an estimated 4,500 in 10 years and 3,500 in 20. Surely we should be looking at halting the population decline and looking to bring people to the area, rather than just accepting the situation.
  • Can lessons be learned from Wemyss Bay and Inverkip as these villages expand but the main towns continue to lose people?

I received a variety of replies. Eric Forbes, our local councillor, was first to reply with a short acknowledgement and commented that these issues are at the forefront of their deliberations which they are trying to resolve daily. Other replies are shown below.

The latest response to be added below was from Annabel Goldie. This means that all of the local politicians I wrote to have now sent a response except, sadly, for the three SNP regional MSPs.

You can also join the Greenock Telegraph's "Fight the Cuts" campaign by filling in a form on this page:
Replies from local politicians:

David Cairns - MP - Labour

Thank you for your recent e-mail. I too was deeply disappointed by NHS Argyll and Clyde’s decision to change the status of the Rankin to a midwife lead unit and, as you say, the ENT ward was transferred to Paisley some time ago. Hospitals are an important part of a community, and you are right in thinking that the lack of full NHS facilities may well play a part in people’s decision to live in Inverclyde. Your point about the Southern General is well made, and it is something I intend to highlight in my discussions with NHS Argyll and Clyde.

The report by NHS Argyll and Clyde proposing the closure of Ravenscraig and the reduction of services at Inverclyde Royal Hospital is a major worry for all of us who live in Inverclyde. People will ask, understandably, why these moves are being proposed at a time when the Government has increased spending in the NHS to record levels.

The problems the Health Board faces are real: such as our falling population, shorter working hours for Doctors, and the difficulties in attracting younger Consultants to Inverclyde. I'm told that if we recruited every school leaver in Scotland with the right grades to study medicine, we still would not have enough doctors to maintain the status quo. All of this forces change.

However, I have very strong reservations about the rush to centralise services, which is the all-too-frequent response of Health Boards across Scotland. I also have very grave concerns about the ability of the Royal Alexandra in Paisley to cope with the additional numbers, as well as the strain that this will put on such other services such as ambulances.

There are some things to be welcomed in the report, such as the possible expansion of services provided by our GPs at the hospital itself and the retention of some elective surgery, but on the whole it is clearly not good news. We also welcome the commitment to have an independent referee to make sure that the process is fair and balanced, (unlike previous consultations).

We have to offer another way forward. The people of Inverclyde deserve an alternative, not a slogan. During the coming months, together with Duncan McNeil MSP, trade union representatives and clinicians, I aim to embark on an extensive consultation exercise to frame alternative, realistic and achievable proposals which would maximise local access to services and retain employment levels here in Inverclyde.

I share your concerns about the falling population in Inverclyde. As we have seen, this has an impact on our schools and, if parents have to send their children to a school far from home, they may be unwilling to remain in the area. Wemyss Bay and Inverkip are vibrant villages, which are growing and have a real sense of community, something that is sadly lacking in other parts of Inverclyde. There is indeed much we can lean from them, and I hope that one day you will return to Inverclyde and live in our midst once again.

Returning to the subject of our local hospitals please be assured that I am not taking this lying down and will keep you informed about our campaign.

Yours sincerely
David Cairns MP
Greenock and Inverclyde

Murray Tosh - Regional MSP - Conservative

Thanks for the message. I fully understand your comments about the IRH, and indeed I have been hearing similar concerns over the past year, in connection with the Vale of Leven hospital, about the relentless centralisation of hospital services in Argyll and Clyde (and, indeed, Greater Glasgow). It may well be that the loss of the hospital will affect individuals' and families' location decisions. I will support the retention of as many services at IRH as possible.

Your point about access to the RAH seems a very valid one, and I will raise concerns with signage from the trunk roads network with the relevant authorities. The prospect that people will choose to go to the Southern General rather than the RAH is a very real one, and could well undermine the objectives set out by NHS Argyll and Clyde in last week's review document.

The population of Inverclyde, and indeed Renfrewshire (although to a lesser extent) has been falling in recent years, clearly in response to the local employment situation, and people's expectation of how the local economy will perform. The Registrar General's projections show that Inverclyde will continue to lose people in the years to come, and this is obviously a matter of some concern.

I anticipate that efforts will continue to try and bring in industry, and support local businesses, as people will leave otherwise for better prospects elsewhere. I also support the proposed upgrading of schools as an essential step to convince people to locate their families in the area, and I think that the same is true about the proposed transfer of local authority housing stock, which is the key to substantial investment locally, and to providing local people with decent houses to replace some of the grimmer old estates.

I'd suggest that the lessons from Inverkip and Wemyss Bay are that people will live in Inverclyde in good environments, with good employment and incomes, and that policy must be geared to providing work and good environment throughout Inverclyde. Outside agencies, like the Executive and the enterprise agencies, have a lot to contribute, but so too has Inverclyde Council, which needs to drive forward investment in housing and education.

Murray Tosh

Duncan McNeil - MSP - Labour

Thank you for your e-mail.

NHS Argyll and Clyde’s Clinical Strategy is not good news and must be opposed.

The proposals to close Ravenscraig and the reduction of services at Inverclyde Royal Hospital are a major worry for all of us who live in Inverclyde. And I understand that people will ask, not unreasonably, why these moves are being proposed at a time when the Government has increased spending in the NHS to record levels.

There are some things to be welcomed in the report, such as the possible expansion of services provided by our GPs at the hospital itself and the retention of some elective surgery. I also agree that we need to modernise elderly care and mental health services. In addition, the strategy is right to call for the introduction of one-stop clinics, more flexible opening hours for healthcare facilities and the better use of technology. I also welcome the commitment to have an independent referee to make sure that the process is fair and balanced, (unlike previous consultations).

But this cannot mask the fact that, on the whole, this very hard document will not change local health services in our favour

I do accept that the problems the Health Board faces are real: our population, for example, is falling; doctors have shorter working hours; and general hospitals experience difficulties when competing with university-led services in Glasgow to recruit clinicians. Indeed, as things stand, even if we recruited every single school leaver in Scotland with the right grades to study medicine, we would still not have enough doctors to maintain the status quo.

However, I think trying to deal with this by simply rushing to centralise services - the all-too-frequent response of Health Boards across Scotland - is ludicrous. I also share your concerns about the ability of the Royal Alexandra Hospital in Paisley to cope with the additional numbers which it will require to treat and about the strain which will be put on others, such as the Ambulance Service. You certainly have a point that people would probably be better advised to simply travel on to the world class university-led services a few miles up the road in Glasgow than make their way through the housing schemes of Paisley on the way to the RAH.

I believe that our only option is to offer a different way forward - a real alternative, not another slogan. That is why David Cairns MP and I have already discussed the matter with the trade unions and met with clinicians. I am also in the process of seeking to recruit an expert academic to examine the Board’s plans and help us draw up our own realistic and achievable proposals which would look to maximise local access to services and retain employment levels here in Inverclyde.

On the wider issues you raise, regarding local schools and our falling population, I absolutely agree that we should not be accepting that decline is inevitable. Once we do that, it becomes a self fulfilling prophecy. Sadly, however, with its (lack of a) school building programme, Inverclyde Council does not seem to share this view.

As you will doubtless be aware, I have long been at odds with the current administration of Inverclyde Council over their prevarication on the future of our schools. Sadly, much to my intense frustration, as the matter of schools reprovisioning is the responsibility of the elected local authority, I have no direct power as an MSP to instruct Inverclyde Council to act in a certain way. That being said, I have made no secret of my opposition to their plans and I can assure you that I will continue to make the case against Inverclyde’s children receiving a second-class education.

The issue of schools is central to the future of Inverclyde. Families will only make Inverclyde their first choice to locate if, among other things, they are confident their children will receive a first class education in a warm, safe 21st Century classroom.

For more information, you may wish to read an article I wrote on the subject of regeneration and reversing population decline, which is online at http://www.duncanmcneil.com/News/Articles/Column_020302.htm

I hope this is helpful and thank you for taking the time to get in touch.

Best wishes,

Ross Finnie - Regional MSP - Liberal Democrats

Thank you for your email of 3 June concerning Inverclyde Royal Hospital and Inverclyde in general. Clearly the document issued by NHS Argyll & Clyde raises a number of fundamental issues and questions such as you raise in your email. I am unhappy with the proposals and I can assure you that I will be pursuing all of these issued with NHS Argyll & Clyde.

On the wider issue of Inverclyde I have had a number of meetings with both the local authorities and Scottish Enterprise Renfrewshire on the question of developing strategies to arrest population decline. Matters are at early stage but the various bodies recognise the problem and more radical plans are being drawn up with a view to addressing the problem.

Ross Finnie MSP

Frances Curran - Regional MSP - Scottish Socialist Party

Your e-mail raises a whole number of issues. Yes there is a population decline. But it is not about to be reversed given the health board proposals. They are proposing that the IRH becomes a glorified health centre, open 9-5.

These proposals represent the biggest crisis in the NHS since it was founded. Last year 16,000 people were admitted to the IRH and almost 10,000 at the Vale of Leven Hospital also proposed for closure. People in Paisley should also be worried, where are all these admissions going to go when the RAH is already full.

I will be fighting the closure of all 6 hospitals listed in the consultation, I will be launching the campaign at a public meeting in Greenock Town Hall on the 22 June.

Frances Curran

Annabel Goldie - Regional MSP - Conservative

I fully understand your concerns surrounding the downgrading of Inverclyde Royal Hospital and only yesterday I spoke in a debate in Parliament urging the Health Minister to intervene in NHS Argyll & Clyde's Consultation on its Clinical Review and I enclose a copy of my speech (shown below).

The current proposals from the health board are unworkable and are not what the people of Argyll & Clyde want. Taking health care services away from local communities and concentrating them at the Royal Alexandra Hospital in Paisley is in my opinion unworkable. The mere accessibility of this hospital is problematic.

I would urge you to make a submission to NHS Argyll & Clyde regarding their consultation and I will of course be making a submission myself and I will send you a copy of this in due course.

Yours sincerely,
Annabel M Goldie MSP
West of Scotland Region

Parliament speech - Thursday 1st July, 2004:

"Miss Annabel Goldie (West of Scotland) (Con): I, too, commend Frances Curran and congratulate her on the passion of her speech, because she is striking a chord that resonates within every person in the chamber and in the areas that are affected.

Hospital provision is now a vital issue, not just for Argyll and Clyde but for a wider part of Scotland. Those of us who attended the meeting of the save Stobhill campaign on Monday evening will be aware of how intense passions are in respect of Greater Glasgow NHS Board's proposals. That situation is echoed throughout Scotland. The minister must be sensitive to that and be willing to show a listening ear, because the themes that are emerging on this broad base are common to all areas.

Health care for local communities is disappearing or is in threat of disappearing and local communities feel more and more distant, not just from the care but from having a say in the kind of care that they need. There is increased centralisation. Questions arise, such as what the role of the health boards is, what the role of Government is, and what the role of clinicians is. There is a feeling that patients have too little say and Government has too much control. For that reason, my party supports foundation hospitals. We believe in trying to offer greater choice and giving patients the opportunity to have a greater say on the provision of care. It is important that we understand the general backdrop against which the debate takes place. It is easy to be critical of Argyll and Clyde NHS Board—I share many of the criticisms that Frances Curran articulated—but the board is purely a bureaucratic deliverer of what it is told to provide within a fixed package of resource. That goes right to the heart of who the provider is—it must be Government.

I have read the summary of the consultation document and it seems to me that the proposals are a threat to six hospitals, which will affect hundreds of thousands of people in an area with difficult geography. We should not forget that the geography of the Argyll and Clyde NHS Board area is particularly challenging, which gives rise to problems for communities in accessing the care that they need. A three-month period for a consultation on such proposals is simply unacceptable.

I turn to the specific proposals for Inverclyde royal hospital and the Vale of Leven hospital. We cannot deny those areas the hospital care to which they are entitled. The consultation presents the proposals as an option, but I share Frances Curran's concern about what people are being consulted on. People are being told, "Here it is—take it or leave it." That is not good enough. There are legitimate arguments about the kind of care that the population mass in Inverclyde and in the Vale of Leven are entitled to expect. The proposals place a question mark over the current provision from those hospitals, with a view to concentrating everything in the Royal Alexandra hospital in Paisley. In my opinion, that would be impossible because the location of that hospital is difficult, development is constrained by the site and access is problematic — it is one of the most difficult hospitals to get to.

The review is not shaping the future; for the area concerned, it is hospital provision meltdown. The proposals are not safe or accessible and they are not acceptable. The consultation should be extended to at least six months. Ideally, the minister should intervene to revisit what the health board is talking about before the consultation process continues. What is at stake is far too important and enduring for the future of the area concerned to leave to something as unacceptable and inadequate as the current proposals." (Scottish Parliament, Official Report, Thursday 1st July 2004)

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